Managing gastroesophageal reflux disease in children: The role of endoscopy

Abstract

Gastroesophageal reflux disease (GERD) is a growing problem in the pediatric population and recent advances in diagnostics and therapeutics have improved their management, particularly the use of esophago-gastroduodenoscopy (EGD). Most of the current knowledge is derived from studies in adults; however there are distinct features between infant onset and adult onset GERD. Children are not just little adults and attention must be given to the stages of growth and development and how these stages impact the disease management. Although there is a lack of a gold standard test to diagnose GERD in children, EGD with biopsy is essential to assess the type and severity of tissue damage. To date, the role of endoscopy in adults and children has been to assess the extent of esophagitis and detect metaplastic changes complicating GERD; however the current knowledge points another role for the EGD with biopsy that is to rule out other potential causes of esophagitis in patients with GERD symptoms such as eosinophilic esophagitis. This review highlights special considerations about the role of EGD in the management of children with GERD.

Correlation between esophageal pH-metry and esophagitis in gastroesophageal reflux disease in children

“…High doses of PPIs are necessary in patients with higher grades of esophagitis or when there are conditions that can determine severe GERD. [ 1 , 18 ] In our study, if the symptoms of children have not completely resolved, the treatment has been extended for a longer period of time (another 6–8 weeks). When patients are with high grades of esophagitis at first upper digestive endoscopy, or they have persistent symptoms after an adequate treatment, or in case of atypical symptomatology, we can follow up performing another endoscopy.…”

Gastroesophageal Reflux in Critically Ill Children: A Review

“…They are not the methods of choice for the diagnosis of GER as they have a high rate of false positives and negatives [2, 20]. …”

“…Gamma scan studies can detect slowing of gastric emptying and the presence of silent aspiration; however, it is not routinely indicated for the diagnosis of GER in children [2, 20]. …”

“…In addition, the technique is useful for monitoring the clinical course of Barrett's esophagus [2, 20]. Endoscopy is only indicated if there is a suspicion of complications of GER.…”

Evaluation of Esophageal Pathology in Children Who Underwent Esophagogastroduodenoscopy

“…Endoskopik görünümü normal olan hastaların 11'nin patoloji sonucu reflü özofajiti ile uyumu gelirken, bir hastada EO saptandı (Tablo IV). Özofagus patolojisi olan hastaların endoskopik ve patolojik özellikleri.Özofagus mukozasında görülen kızarıklık, solukluk, damarlanma artışı veya azalışı oldukça öznel ve spesifik olmayan bulgulardır(16). Özofagus patolojilerinin endoskopik sınıflandırılmasında yorumlamaları standardize etmek için çocuklarda en sık Los Angeles sınıflaması kullanılmaktadır(6,18).…”